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WELL PERMIT APPLICATION FORM UNIT IV <br /> SAN JOAQUIN COUtr-yi i PUBLIC 'r-E,—\LT-1 SER` IC�� � <br /> ENVIRONMENTAL HEALTH DfViSION (PHS-F-HO) <br /> 304 E. Weber, Third Floor, Stockton, CA., 95202 <br /> (209) 46$-349 1-71 <br /> NCN-REFUN $ c 3PERW EXPIRES-1 YEAR FRCM CATs ISSsJc : <br /> 2 Z- <br /> oarat an a`*rebv rr ace o San Joaquin Cour"i-nr a a=;I:to=nstru=arr!!ar MINI 2%A wOtk USC bm-C Tolls act ICF O*i s m4wa v <br /> ri.iosgwn Cdu•try Ceveloarnattt-rd* 01130 sr 9-t'i5 3 arra the sr.wcaras of San soaaurr.Gaunsy?�N3 c Hea-m Se-�=Es St=.ro^m:r�al l�eAli#; Avi=ian <br /> alssessul_ <br /> aLt Lacat�on J4�:, Cuss S-ne. 143!A l Mk�t'!';'-j i rr;. z o arceW <br /> OPERTf Owner ,Add?ess <br /> 37 Cant-aclorJhdcrass <br /> ` r 1 f44 <br /> r 1 � �`_ �•'� �}�__Cs �r.�.r L�'7���f�nore�� - r 7 y� �£ -� <br /> nsultazt'Sub CDr►tra�r;.��r�.C�r _.9��n'�iaarass,�Z �- 1e�*. S�^rtt�`C y r- L L,c�slo� ��o�etF,��`�3�c=": ]-"� <br /> L <br /> 3;.flordlnates :. � Tax^stua Ra^g� e=v n <br />�Rtt YC 9E a@FtFU'14�AEC <br /> VEE '8�GFUNG, C:Wt G90PROBE HIfOROPU1 IC-1 1-!ANO-AUGES 0T?i%R" L --Z75-'2ZUCTrN <br /> X-SciL BORING;* g J.F-ft 9OR, <br /> fl PRSSS-R=-GROLT <br /> then <br /> JMFAEN i S <br /> IPE OF'NELL INSTALLA-ION TYPE CONSIMUCTICN 4PFICIFECA-1QNS <br /> NIO%9TCRMC f�--40LLU STEM OW OF SCRE-iOLE "'1LjL-'7 '-S CASINGS-,'3"ES i'4C :SELL A5-NG CLA <br /> zX t1AG'f]CN 13 AsR:WI11ME�,'L'R{VEN CA31M1tO-MICKNESS TfPS jF ,:•SiM1I G S%9. Q P'rC (jC--ER <br />`.1 }1 MUD 50"ARY CiEPTH QF r.ACUT SEAL, TRcyEIE i�rC T�� 3C..a LJ O AUGEFS 0HoSF <br /> 4I ^R3E 13 P;,Stt z'C NT GROUT SEAL PtJ ?RFs Gy--s a&a (NATE. MAXIMUM FREE-FALL DEPTH 13 30') <br /> SCIL BOR'NG 12 RANO AUGER RPPROX WRING DEFT14 '_�+zL(—. a• a+S-'O'L+S -s,1E <br /> C KED _ __ 13 OTHEI C04DUCT4R CASING PRC 0ScC-' ' T'YEAS s:soac-r-mat c-s mart) <br />]aAMFVMTS <br /> NOTE- OFFSITE BC3RING5 REQLIRIE ACCESS OR ENCROACHMENT PERMITS <br /> ereav zo-oy t-ar I nave p,---zxea this=12,carne arta that She wxK&JI�!s done in;ir. raarrz-vu. ,San Joacuir t_..r!Orznu-&q S-=re Lames and Rules <br /> d P@Ct'dnl0t19 o{"San .13a"Lt) "r ae&brmanue CT inn=Wo:A <br /> r wnrey tfirs Paraffri tis.slued,I shaft aat amRsay+e7ersacr9 s�tbfsct tv 1Nf)f�t{E�RS COMPEALT ATIGN Laws <br /> rs7SCtlt S+grTatLr!a�ltlFres iha krll�,v+r>g "r M•p'�, <br /> that art the pert imam of Me t.artc`Cr w7wn tll z C6;-,-ft rs rssl.BO sr�r_nscray psr5c^s Sr.c�^ra <br /> OQi{c'�S' Mracr+5,1�"i=La%s of Cart M.*. <br /> CALL ThE UNFT N MPSCTOR WORKING-HRS IN ADVANCE FOR ALL REQUIRED IKSPECTiO_NS <br /> Omar, <br />-ret hauls I f^t .,.. �.�iWr, Dacca <br /> 5EE SETS-- A-P IN UN1 i JV W0F K-:Pf*-A,N DATEDT <br /> 3}SPAR-fMSST USS CKL" <br /> 7pC=t2Cn Aic repm � " G z Cate lss.jec�._�^ --- - a.— <br /> rC>ss�nsL'sG'Dn By Dacsr tna1 nam:;' <br /> is>+w=en '-,avrc�on 3ti Pass <br /> 01111ME11 TS t CONOiTig"a_ <br /> ACCCU14 T NO ONLY AiCA ! <br />? ES FES'NFO AuolDw Rp-m an CKmy,.4 k REC13 By ` OAT/E i pr;RMIT 3E�SliCC L EQuBST x Itf'>T%`DE <br /> i.:S�2Cva <br />